25 results on '"Alobid, Isam"'
Search Results
2. Assessing the effect of absorbable steroid sinus implant: a state-of-the-art systematic review.
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Calvo-Henriquez, Christian, García-Lliberós, Ainhoa, Sánchez-Gómez, Serafin, and Alobid, Isam
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ENDOSCOPIC surgery ,BIOABSORBABLE implants ,SURGICAL stents ,RESEARCH questions ,STEROIDS ,HEALING ,MAXILLARY sinus diseases ,TOOTH sensitivity - Abstract
Objectives: Endoscopic sinus surgery is not a definitive treatment for chronic rhinosinusitis (CRS). The use of sinus stents after surgery to maintain sinus patency and deliver local steroids has gained popularity. The first steroid-eluting bioabsorbable implant (SEBI) approved for this indication, later Propel, was developed in 2011. This state-of-the-art review aims to summarize the available evidence, as well as to point out potential pitfalls and lack of specific analyses to guide future research on this new therapeutic option. Data sources: Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. Review methods: Nine research questions were defined: Are steroid-eluting Sinus implants useful for the control of CRS symptoms after surgery? Do they improve surgical field healing after CRS surgery? Do they decrease polyp regrowth after ESS? Do they decrease the need for ESS? Are they useful in symptom control as in-office procedure? Are they better than other steroid-impregnated resorbable materials? Do they have a positive impact on olfaction? Are they safe? Are they cost-effective? Retrieved articles were reviewed by two authors. Results: Twenty nine studies were included: 3 metanalysis, 1 systematic review, 10 randomized clinical trials, 4 quasi-experimental studies, 1 retrospective cohort study, 4 cost studies, 3 case series and 2 expert consensus. The review encompassed a population of 3,012 patients treated with SEBI and 2826 controls. Conclusions: This is the first state-of-the-art review assessing steroid eluting bioabsorbable stent evidence. Despite the effort in recent years, still several questions remain unanswered. This review will hopefully guide future research efforts to better define the role of SEBI in the otolaryngology practice. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Greater palatine artery pedicled flap for nasal septal perforation repair: radiological study and case series
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Santamaría-Gadea, Alfonso, Vaca, Miguel, de los Santos, Gonzalo, Alobid, Isam, and Mariño-Sánchez, Franklin
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- 2021
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4. EUFOREA/EPOS2020 statement on the clinical considerations for chronic rhinosinusitis with nasal polyps care.
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Hellings, Peter W., Alobid, Isam, Anselmo‐Lima, Wilma T., Bernal‐Sprekelsen, Manuel, Bjermer, Leif, Caulley, Lisa, Chaker, Adam, Constantinidis, Jannis, Conti, Diego M., De Corso, Eugenio, Desrosiers, Martin, Diamant, Zuzana, Gevaert, Philippe, Han, Joseph K., Heffler, Enrico, Hopkins, Claire, Landis, Basile N., Lourenco, Olga, Lund, Valerie, and Luong, Amber U.
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NASAL polyps , *ENDOSCOPIC surgery , *SINUSITIS , *REOPERATION , *PHYSICIANS , *ASPIRIN - Abstract
Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP. [ABSTRACT FROM AUTHOR]
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- 2024
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5. "Boot-on-Donut" procedure for anterior and large septal perforation.
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Alobid, Isam and Bernal-Sprekelsen, Manuel
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NASAL septum , *ENDOSCOPIC surgery , *ARTERIES - Abstract
Background: Surgical closure of large nasoseptal perforation (NSP) is challenging. The use of an extended anterior ethmoidal artery (eAEA) flap to reconstruct NSP may present with difficulties for NSPs which have their upper edge in a high position. Method: We propose adding a "donut-shape" flap from surrounding septal tissue to the eAEA flap. Thus, the inverted edges of this flap allow to cover the uppermost aspect of the NSP. A series of 18 patients with complete closure of NSPs was included. Conclusion: This novel "Boot-on-Donut" technique consisting of the eAEA flap (Boot) and inverted edges (Donut) is a feasible procedure that allows to reconstruct large NSP located superiorly. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Innovative Surgical Techniques for Nasal Septal Perforations: Management and Treatment
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Santamaría-Gadea, Alfonso, Mariño-Sánchez, Franklin, Arana-Fernández, Beatriz, Mullol, Joaquim, and Alobid, Isam
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- 2021
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7. Management of patients with chronic rhinosinusitis with nasal polyps in Spain: learnings from a nationwide survey of otorhinolaryngologists.
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Alobid, Isam, Liesa, Rafael Fernández, Aubá, Jose Miguel Villacampa, Moure, Abraham L., Sánchez-Herrero, M. Guadalupe, and del Cuvillo Bernal, Alfonso
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NASAL polyps , *OTOLARYNGOLOGISTS , *ENDOSCOPIC surgery , *SINUSITIS , *VISUAL analog scale , *PATIENT reported outcome measures , *REOPERATION - Abstract
Purpose: To describe the self-reported practices on the diagnosis, treatment, and follow-up of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) by ear, nose, and throat (ENT) specialists in Spain to identify potential areas for management optimization. Methods: A cross-sectional online survey with 16 questions was carried out. Recruitment was performed by emailing registered ENT specialists in the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC). Results: In total, 127 ENT specialists completed the survey. Fifty-one percent of respondents combined clinical criteria and objective evidence of mucosal inflammation to diagnose CRSwNP. Patient interview and, to a lower degree, a visual analogue scale were the most employed diagnostic tools to quantify symptom severity. Less than half (45%) routinely used the 22-item sino-nasal outcomes test (SNOT-22) to assess the impact of CRSwNP disease in quality of life. The use of patient-reported outcomes and other clinical evaluation tools showed a larger uptake among ENT specialists that worked at an ENT department with an available rhinology unit. Almost all the specialists surveyed (95%) recommended biological treatment, particularly in patients with uncontrolled CRSwNP with respiratory comorbidities (76%), as well as in candidates for revision surgery (66%). Conclusion: Spanish otorhinolaryngologists showed a trend toward incorporating CRSwNP guideline recommendations in their clinical practice. The observed low uptake of patient-reported outcomes and objective clinical evaluation tools in routine clinical practise have been identified as areas for optimizing the management of patients with CRSwNP. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Upregulation of Platelet-Activating Factor Receptor Expression and Lyso-Platelet-Activating Factor Isoforms in Human Nasal Polyp Tissues.
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Roca-Ferrer, Jordi, Pérez-González, Maria, Alobid, Isam, Tubita, Valeria, Fuentes, Mireya, Bantulà, Marina, Muñoz-Cano, Rosa, Valero, Antonio, Izquierdo, Iñaki, and Mullol, Joaquim
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NASAL polyps ,GENE expression ,ENDOSCOPIC surgery ,NASAL mucosa ,ASTHMATICS ,RESPIRATORY diseases - Abstract
Background: The Platelet-Activating Factor (PAF)/receptor (PAFR) system is involved in asthma and allergic rhinitis; however, its role in chronic rhinosinusitis (CRS) is still unclear. This study aimed to assess the expression of PAFR and the concentration of Lyso-PAF isoforms in the nasal polyps (NP) of patients suffering from CRS with/without comorbidities such as asthma and NSAID-exacerbated respiratory disease (N-ERD) compared to healthy nasal mucosa (NM) from control subjects. Methods: NM (n = 8) and NP tissues were obtained from patients undergoing surgery for septal deviation/turbinate hypertrophy or endoscopic sinus surgery, respectively. Three phenotypes were studied: CRSwNP with no asthma (n = 6), CRSwNP with non-steroidal anti-inflammatory drug (NSAID)-tolerant asthma (n = 6), and CRSwNP with NSAID-exacerbated respiratory disease (n = 6). PAFR protein and mRNA were assessed via immunochemistry, immunofluorescence, Western blot, and real-time quantitative PCR. Lyso-PAF isoforms (C16, C18, and C18:1) were quantified via mass spectrometry. Results: PAFR protein was expressed in the NM and NP, concretely in epithelial cells and submucosal glands. Compared to NM, PAFR mRNA expression was higher in all NP phenotypes (p < 0.05) while all Lyso-PAF isoform concentrations were higher in the NP from asthmatic patients (p < 0.05). Lyso-PAF C16 and C18 concentrations were higher in the NP from asthmatic patients than in the NP from patients without asthma. Conclusions: The PAF/PAFR system could play a pathophysiological role in CRSwNP pathogenesis. [ABSTRACT FROM AUTHOR]
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- 2023
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9. The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review.
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Calvo-Henriquez, Christian, Viera-Artiles, Jaime, Rodriguez-Iglesias, Miguel, Rodriguez-Rivas, Paula, Maniaci, Antonino, Yáñez, Miguel Mayo, Martínez-Capoccioni, Gabriel, and Alobid, Isam
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IRRIGATION management ,NASAL polyps ,NASAL irrigation ,SINUSITIS ,PARANASAL sinuses ,ENDOSCOPIC surgery - Abstract
Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study.
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Blanco-Aparicio, Marina, Domínguez-Ortega, Javier, Cisneros, Carolina, Colás, Carlos, Casas, Francisco, del Cuvillo, Alfonso, Alobid, Isam, Quirce, Santiago, and Mullol, Joaquim
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NASAL tumors ,NASAL polyps ,AIRWAY (Anatomy) ,DELPHI method ,INFLAMMATION ,LIKERT scale ,ENDOSCOPIC surgery - Abstract
Background: Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. Methods: Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7–9), uncertain (4–6) or inappropriate (1–3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. Results: A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios. Conclusion: We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps.
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Ceballos Cantu, Juan Carlos, Alobid, Isam, and Mullol, Joaquim
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NASAL polyps ,SINUSITIS ,BIOTHERAPY ,THERAPEUTICS ,CLINICAL indications ,ENDOSCOPIC surgery - Abstract
A clear understanding of the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) and its close association with other airway pathologies, especially asthma, helps to comprehend the concept of the united airway and the importance of a multidisciplinary approach and the actual roll of biologic therapy. This expert review is the synthesis of a working group on the current state of the art of the evaluation and management of CRSwNP. A thorough analysis of the literature has been conducted for the latest studies and results, specially the European (EPOS 2020) and American (ICAR-RS 2021) guidelines. The roles of optimal medical treatment and indications for surgery are becoming clearer, but much research is still needed regarding the extent and radicality when surgery is indicated. The main objectives of this review were to provide a clear and updated description of treatments, their indication, follow-up, and response criteria. These steps are considering the broad spectrum of inflammation endophenotypes and the biologic therapy available. Understanding the role and limitations of each specialty is key for providing greatest benefit to the patient. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Endoscopic superior eyelid transorbital approach: how I do it.
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Di Somma, Alberto, Sanchez España, Juan Carlos, Alobid, Isam, and Enseñat, Joaquim
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SKULL base ,SURGICAL & topographical anatomy ,EYELIDS ,ENDOSCOPIC surgery ,SKULL surgery ,OPERATIVE surgery - Abstract
Background: The endoscopic transorbital approach to the skull base is currently growing in popularity, and it is nowadays progressively used as a skull base approach. Clinical experience, along with detailed anatomical knowledge, makes this technique safe and effective. Method: We present a step by step description of our technique based on the most recent anatomic references, and clinical experience. In order to better understand every phase of the procedure, we propose to keep on the following scheme, that is (1) skin phase; (2) working space; (3) lesion removal; (4) reconstruction. Hence, alone or in combination with the well-known endonasal pathway, the transorbital avenue seems to be a useful approach for selected skull base lesions. We present our technique, along with an anatomic analysis on cadaveric specimens. Conclusions: Detailed knowledge of surgical anatomy, and a specific stepwise analysis of each part of the surgical procedure, is notably useful in order to safely and effectively perform a superior eyelid endoscopic transorbital surgery to the skull base. [ABSTRACT FROM AUTHOR]
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- 2022
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13. Extended Anterior Ethmoidal Artery Flap: Novel Endoscopic Technique for Large Septal Perforation.
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Santamaría‐Gadea, Alfonso, Langdon, Cristobal, and Alobid, Isam
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View Video S1Laryngoscope, 132:298–300, 2022 [ABSTRACT FROM AUTHOR]
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- 2022
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14. Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography.
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Amin, Nikul, Walker, Abigail, Alobid, Isam, Anari, Shahram, Bast, Florian, Bhalla, Rajiv K., Cathcart, Russell, Harries, Philip G., Hathorn, Iain, Philpott, Carl M., Ramakrishnan, Yujay, Stew, Benjamin, Surda, Pavol, Ting, Fiona, and Hopkins, Claire
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MAXILLARY sinus surgery ,MAXILLARY sinus ,DENTAL implants ,ENDOSCOPIC surgery ,COMPUTED tomography ,PARANASAL sinuses - Abstract
Objectives: Conebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment. CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery. We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons. Design: The RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria. Setting: A virtual panel of 13 international experts in ESS. Participants: The expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decision‐making processes. Main outcome measures: To define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT. Results: Patients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus. For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered. Conclusions: This study has developed and reported a list of appropriateness criteria to offer ESS in adult dental implant patients with incidental maxillary sinus findings on CBCT. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Real‐life assessment of chronic rhinosinusitis patients using mobile technology: The mySinusitisCoach project by EUFOREA.
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Seys, Sven F., De Bont, Shana, Fokkens, Wytske J., Bachert, Claus, Alobid, Isam, Bernal‐Sprekelsen, Manuel, Bjermer, Leif, Callebaut, Ina, Cardell, Lars‐Olaf, Carrie, Sean, Castelnuovo, Paolo, Cathcart, Russell, Constantinidis, Jannis, Cools, Leen, Cornet, Marjolein, Clement, Gregory, Cox, Tony, Delsupehe, Lieve, Correia‐de‐Sousa, Jaime, and Deneyer, Lauren
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NASAL polyps ,ENDOSCOPIC surgery - Abstract
Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient‐reported outcomes by mobile technology offers the possibility to better understand real‐life burden of CRS. Methods: This study reports on the cross‐sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. Results: The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well‐controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. Conclusion: Real‐life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient‐reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real‐life monitoring, supporting the evolution of care towards precision medicine. [ABSTRACT FROM AUTHOR]
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- 2020
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16. Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings.
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Alobid, Isam, Langdon, Cristóbal, López‐Chacon, Mauricio, Enseñat, Joaquim, Carrau, Ricardo, Bernal‐Sprekelsen, Manuel, Santamaría, Alfonso, Langdon, Cristóbal, López-Chacon, Mauricio, Enseñat, Joaquim, Bernal-Sprekelsen, Manuel, and Santamaría, Alfonso
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Objectives/hypothesis: Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF).Study Design: Anatomical cadaver and radiological study plus case study.Methods: Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair.Results: Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm2 ). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm2 to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications.Conclusions: Radio-anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum.Level Of Evidence: NA. Laryngoscope, 128:1320-1327, 2018. [ABSTRACT FROM AUTHOR]- Published
- 2018
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17. Nasal juvenile angiofibroma: Current perspectives with emphasis on management.
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López, Fernando, Triantafyllou, Asterios, Snyderman, Carl H., Hunt, Jennifer L., Suárez, Carlos, Lund, Valerie J., Strojan, Primož, Saba, Nabil F., Nixon, Iain J., Devaney, Kenneth O., Alobid, Isam, Bernal–Sprekelsen, Manuel, Hanna, Ehab Y., Rinaldo, Alessandra, Ferlito, Alfio, and Eisele, David
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NASAL cavity cancer ,TUMORS in children ,ENDOSCOPIC surgery ,POSTOPERATIVE care ,CANCER radiotherapy ,CANCER treatment - Abstract
ABSTRACT Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017 [ABSTRACT FROM AUTHOR]
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- 2017
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18. Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study.
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Rioja, Elena, Bernal-Sprekelsen, Manuel, Enriquez, Karla, Enseñat, Joaquim, Valero, Ricard, Notaris, Matteo, Mullol, Joaquim, and Alobid, Isam
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HEALTH outcome assessment ,ENDOSCOPIC surgery ,SKULL base ,SMELL ,QUALITY of life ,SINUSITIS ,SURGERY - Abstract
Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA). This study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA ( n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction ( n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL. Level of evidence: IIb [ABSTRACT FROM AUTHOR]
- Published
- 2016
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19. Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life.
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Alobid, Isam, Enseñat, Joaquim, Mariño-Sánchez, Franklin, Rioja, Elena, de Notaris, Matteo, Mullol, Joaquim, and Bernal-Sprekelsen, Manuel
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NEOVASCULARIZATION ,SKULL base ,TUMOR surgery ,ENDOSCOPIC surgery ,SURGICAL flaps ,QUALITY of life ,ADENOMA ,TUMORS - Abstract
Background: Endoscopic transsphenoidal surgery is currently the optimal treatment for skull base tumors. This study was designed to assess patient's sinonasal symptoms and quality of life (QoL) after resection of pituitary adenoma or skull base tumors using vascularized septal flap (VSF) reconstruction. Methods: Patients with pituitary adenoma underwent the transnasal transsphenoidal endoscopic approach (TTEA; n = 38), and patients with other benign parasellar tumors underwent the expanded endonasal approach (EEA; n = 17) with VSF. Assessment of sinonasal symptoms and QoL by the 36-item Short- Form (SF-36) and the 31-item Rhinosinusitis Outcome Measure (RSOM-31) were performed before and 3 months after surgery. Results: At baseline, the total seven-sinonasal symptom score (T7SSS) was similar between both groups. After surgery, T7SSS significantly increased in EEA but not in TTEA patients. EEA patients reported more smell loss (40.1 ± 26.2; p < 0.05) and posterior nasal discharge (49.3 ± 30.1; p < 0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5, respectively). At baseline, both groups had poorer SF-36 compared with the general population. TTEA patients had poorer QoL (on general health, vitality, and mental health) than EEA patients. After surgery, TTEA patients showed impaired physical role and bodily pain compared with baseline, and EEA patients showed impaired physical role and mental health. At baseline, RSOM scores were similar in TTEA and EEA groups. After surgery, EEA but not TTEA patients reported poorer nasal and general symptoms. Conclusion: The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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20. Nuclear Translocation of the Glucocorticoid Receptor in Fibroblasts of Asthmatic Patients with Nasal Polyposis Insensitive to Glucocorticoid Treatment.
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Embid, Cristina, Fernández-Bertolín, Laura, Pujols, Laura, Alobid, Isam, Mullol, Joaquim, and Picado, César
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NASAL polyps ,GLUCOCORTICOID receptors ,FIBROBLASTS ,ASTHMATICS ,ENDOSCOPIC surgery ,DRUG tolerance ,NONSTEROIDAL anti-inflammatory agents ,THERAPEUTICS - Abstract
Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2011
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21. Reduced expression of COXs and production of prostaglandin E2 in patients with nasal polyps with or without aspirin-intolerant asthma.
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Roca-Ferrer, Jordi, Garcia-Garcia, Francesc J., Pereda, Javier, Perez-Gonzalez, Maria, Pujols, Laura, Alobid, Isam, Mullol, Joaquim, and Picado, Cesar
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PROSTAGLANDINS ,NASAL polyps ,FIBROBLASTS ,ENDOSCOPIC surgery ,ENZYME-linked immunosorbent assay ,ASPIRIN ,INFLAMMATION ,NASAL mucosa - Abstract
Background: Researchers have debated whether regulation of the COX enzymes (COX-1 and COX-2), which mediate production of prostaglandins (PGs), affects the pathogenesis of nasal polyps (NPs) and aspirin-intolerant asthma (AIA). Objective: We investigated the roles of PGE
2 , COX-1 and COX-2, and PGE2 receptors in the development of NPs and AIA by measuring their expression in fibroblasts derived from nasal mucosa (NM) and NPs. Methods: Fibroblasts were isolated from the NM of subjects without asthma who had septal deviation, turbinate hypertrophy, or both (control subjects, n = 7); NPs of aspirin-tolerant nonasthmatic patients (n = 7); and NPs of patients with asthma who were intolerant of aspirin (n = 7). Polyp samples were collected during endoscopic surgery. Cultures were stimulated with IL-1β (10 ng/mL) for 72 hours. We used ELISA, immunoblotting, and immunofluorescence analyses to measure secretion of PGE2 , expression of COX-1 and COX-2, and expression of the PGE2 receptors EP1 to EP4. Results: Compared with NM from control subjects, PGE2 concentrations were significantly lower in IL-1β–stimulated fibroblasts from patients with NPs who were tolerant to aspirin and even lower in polyps from patients with AIA. Similarly, IL-1β exposure induced the expression of COX-1 and COX-2 in fibroblasts from NM of control subjects, had only moderate effects on fibroblasts from NPs of aspirin-tolerant nonasthmatic patients, and almost no effect on fibroblasts from NPs of patients with AIA. IL-1β also induced expression of EP2 in fibroblasts from control NM but not in fibroblasts from NPs of aspirin-tolerant nonasthmatic patients or those with AIA. Conclusion: Alterations in the COX pathway (ie, reduced production of PGE2 and lack of upregulation of COX-1, COX-2, and EP2 under conditions of inflammation) are associated with NPs in patients with or without AIA. [ABSTRACT FROM AUTHOR]- Published
- 2011
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- View/download PDF
22. Does Low-Field Intraoperative Magnetic Resonance Improve the Results of Endoscopic Pituitary Surgery? Experience of the Implementation of a New Device in a Referral Center.
- Author
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García, Sergio, Reyes, Luis, Roldán, Pedro, Torales, Jorge, Enseñat, Joaquim, Halperin, Irene, Hanzu, Felicia, Langdon, Cristobal, and Alobid, Isam
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- *
MAGNETIC resonance , *ENDOSCOPIC surgery , *PITUITARY surgery , *REFERRAL centers (Information services) , *RADIOLOGY - Abstract
Objective To assess the contribution of low-field intraoperative magnetic resonance (iMRI) to endoscopic pituitary surgery. Methods We analyzed a prospective series of patients undergoing endoscopic endonasal surgery for pituitary macroadenomas assisted with a low-field iMRI (PoleStarN30, 0.15 T [Medtronic]). Clinical, radiologic, and surgical variables were analyzed and compared with our fully endoscopic historic cohort operated on without iMRI assistance. A bibliographic review of pituitary surgery assisted with iMRI was conducted. Results Thirty patients (57% female; mean age, 55 years) were prospectively analyzed. The most frequent tumor subtype was nonfunctioning macroadenoma (50%). The average Knosp grade was 2.3 and mean tumor size was 18 mm. Surgical and positioning time were 102 and 47 minutes, respectively. Hospital stay and complication rates were similar to our historical cohort for pituitary surgery. Mean follow-up was 10 months. Complete resection (CR) was achieved in 83% of patients. Seven patients (23%) benefited from iMRI assistance and achieved a CR in their surgeries. All patients except 1 experienced hormonal activity remission. iMRI sensitivity and specificity was 0.8 and 1, respectively. Although not statistically significant, CR rates were globally 11.5% superior in iMRI series compared with our historical cohort. This difference was independent of cavernous sinus invasiveness grade (CR rate increased 12.5% for Knosp grade 0–2 and 8.1% for Knosp grade 3–4). Conclusions Low-field iMRI is a useful and safe assistance even in advanced surgical techniques such as endoscopy. Its contribution is limited by the intrinsic features of the tumor. Further randomized studies are required to confirm the cost-effectiveness of iMRI in pituitary surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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23. The Use of a Three-Dimensional Novel Computer-Based Model for Analysis of the Endonasal Endoscopic Approach to the Midline Skull Base
- Author
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de Notaris, Matteo, Solari, Domenico, Cavallo, Luigi Maria, Enseñat, Joaquim, Alobid, Isam, Soria, Guadalupe, Gonzalez, Joan Berenguer, Ferrer, Enrique, and Prats-Galino, Alberto
- Subjects
- *
THREE-dimensional imaging , *MEDICAL imaging systems , *ENDOSCOPIC surgery , *SKULL base , *NEUROANATOMY , *BRAIN tomography , *MEDICAL communication , *MEDICAL protocols , *PITUITARY surgery , *SURGERY - Abstract
Objectives: To apply a three-dimensional geometric model to various endoscopic endonasal approaches to analyze the bony anatomy of this area, quantify preoperatively bone removal, and optimize surgical planning. Methods: Investigators dissected 18 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy (LSNA) of the University of Barcelona (Spain). Before and after each dissection, a computed tomography (CT) scan was performed to create a three-dimensional geometric model of the approach performed in the dissection room. The model protocol was designed as follows: (i) a preliminary exploration of each specimen using the preoperative CT scan, (ii) creation of a computer-generated three-dimensional virtual model of the approach, (iii) cadaveric anatomic dissection, and (iv) development of a CT-based model of the approach as a result of the superimposition of predissection and postdissection digital imaging and communications in medicine (DICOM) images of specimens. Results: This method employing preliminary virtual exploration of each specimen, the creation of a three-dimensional virtual model of the approach, and the overlapping of the predissection and postdissection three-dimensional models was useful to define the exact boundaries of the endoscopic endonasal craniectomy. Conclusions: Aside from laboratory anatomic dissection itself, this model is very effective in providing a depiction of bony landmarks and visual feedback of the amount of bone removed, improving the design of the craniectomy in the endoscopic endonasal midline skull base approach. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
24. Uso endoscópico del colgajo pericraneal para la reconstrucción nasal y de base de cráneo
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Santamaría Gadea, Alfonso, Alobid, Isam, Enseñat Nora, Joaquim, and Universitat de Barcelona. Facultat de Medicina
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Skull base ,Base del crani ,Cirugía endoscópica ,Base del cráneo ,Ciències de la Salut ,Endoscopic surgery ,Cirurgia endoscòpica - Abstract
[spa] INTRODUCCIÓN: El colgajo pericraneal (CP) ha sido habitualmente utilizado en las reconstrucciones cráneo faciales y de base de cráneo. Su utilidad en los abordajes abiertos se encuentra ampliamente descrita en la literatura. Sin embargo, el avance de las técnicas endoscópicas ha relegado el uso del CP por el de los colgajos endonasales. Al mismo tiempo, este avance representa una oportunidad para ampliar las indicaciones del CP a aquellos abordajes endoscópicos en los que los colgajos endonasales no se encuentren disponibles. OBJETIVO: Este trabajo tiene como objetivo estudiar y analizar el uso del CP en la reconstrucción endoscópica de base de cráneo y del septum nasal. MATERIALES Y MÉTODOS: Se realiza un estudio en tres áreas: 1. Se realiza un estudio anatómico en cadáver fresco en el que se ejecutan reconstrucciones de los distintos abordajes de base de cráneo (abordaje transcribiforme, abordaje transplanum, abordaje clival y abordaje de la unión cráneo-vetebral) y del septum nasal. En todos los especímenes, tras recrear el defecto que se a reconstruir, se realizar una disección clásica del CP y posteriormente se introduce a través de una osteotomía del seno frontal. Por último con un manejo endoscópico se realiza la reconstrucción del defecto. 2. En segundo lugar, se realiza un análisis radiológico en tomografías computerizadas (TC) de los límites de reconstrucción que permite el CP y la estandarización del tamaño del mismo según el defecto que se vaya a reconstruir. Se toma como referencia la pared posterior del conducto auditivo interno. 3. Posteriormente, se realiza un estudio clínico en pacientes con tumores de base de cráneo y perforación septal total en los que no existen opciones reconstructivas endonasales o estas no alcanzan el tamaño suficiente. En ellos, se realiza una reconstrucción endoscópica con CP de sus defectos. RESULTADOS: Las mediciones anatómicas mostraron que el tabique nasal tiene una longitud media de 5,8 ± 0,7 cm, mientras que el colgajo pericraneal presenta un promedio de 18,4 ± 1,3; 18,3 ± 1,3 cm de largo (área media 121,6 ± 17,7; 121,5 ± 19,4 cm2). En todos los especímenes se logró la reconstrucción total de los defectos. En el estudio radiológico, se determinó que para reconstruir defectos secundarios a abordajes transcribriforme, transtuberculum, clival y craneovertebrales, la incisión distal del colgajo pericraneal debe colocarse respectivamente a -3,7 ± 2,0 cm (ángulo -17,4 ± 8,5º), -0,2 ± 2,0 cm (ángulo -1,0 ± 9,3º), +5,5 ± 2,3 cm (ángulo +24,4 ± 9,7º), +8,4 ± 2,4 cm (ángulo +36,6 ± 11,5º), en relación con el punto de referencia. En el caso de la reconstrucción septal, las mediciones radiológicas revelaron que el área del colgajo pericraneal necesaria para reconstruir una perforación septal total sería de 40,9 ± 4,2 cm2, teniendo en cuenta un 30% adicional por la posible retracción durante la cicatrización. Para la reparación total del tabique, el borde distal del colgajo pericraneal debe situarse a 0,8 ± 2,0 cm (3,4 ± 8,78º) del punto de referencia (proyección vertical del canal auditivo externo). Los defectos de la base del cráneo (n = 6) y de la perforación septal total (n=1) en nuestra cohorte clínica se reconstruyeron completamente sin complicaciones. CONCLUSIONES: Este trabajo concluye que el CP presenta un área suficiente para la reconstrucción endoscópica de los distintos abordajes de base de cráneo y septal total. El uso del seno frontal como puerta de entrada a las fosa nasales y el manejo endoscópico del CP en las reconstrucciones es una técnica factible y simple., [eng] The pericranial flap (PCF) has been commonly used in craneo-facial and skull base reconstructions. However, the advance of endoscopic techniques has relegated the use of PCF. At the same time, this advance represents an opportunity to extend the indications of the PCF to those endoscopic approaches in which the endonasal flaps are not available. The aims of this study is to analyze the use of the PCF in the endoscopic reconstruction of the skull base and the nasal septum. An anatomical study on fresh cadaver specimens in which reconstructions of the different skull base defects and nasal septum were carried out. The PCF was introduced through an osteotomy of the frontal sinus. Then, the defects were endoscopically repair. A radiological analysis in computed tomography was performed. The reconstruction limits allowed by the PCF and the standardization of the size of the PCF according to the defect were measured. A clinical study is performed in patients with tumors of the skull base and total septal perforation. In the anatomical study, the nasal septum length and the PCF length and area were obtained. In all the specimens, the total reconstruction of the defects was achieved. The radiological study determined that to reconstruct defects secondary to transcribriform, transtuberculum, clival and craniovertebral approaches, the distal incision of the PCF should be placed respectively at -3.7 ± 2.0 cm, -0,2 ± 2,0 cm, +5,5 ± 2,3 cm, +8,4 ± 2.4 cm, from the reference point (external auditory canal). For total repair of the septum, the distal edge of the PCF should be located 0.8 ± 2.0 cm from the reference point. Defects of the skull base (n = 6) and total septal perforation (n = 1) in our clinical cohort were completely reconstructed. This work concludes that the CP presents enough area for the endoscopic reconstruction of the different approaches of the skull base and total septal perforation. The use of the frontal sinus as the entrance and the endoscopic management of the CP in the reconstructions is a feasible and simple technique.
- Published
- 2018
25. A Three-Dimensional Computer-Based Perspective of the Skull Base.
- Author
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de Notaris, Matteo, Palma, Kenneth, Serra, Luis, Enseñat, Joaquim, Alobid, Isam, Poblete, José, Gonzalez, Joan Berenguer, Solari, Domenico, Ferrer, Enrique, and Prats-Galino, Alberto
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- *
THREE-dimensional imaging , *ENDOSCOPIC surgery , *SKULL base , *NEUROANATOMY , *SIMULATION methods & models , *HUMAN dissection - Abstract
Objective To describe our designed protocol for the reconstruction of three-dimensional (3D) models applied to various endoscopic endonasal approaches that allows performing a 3D virtual dissection of the desired approach and analyzing and quantifying critical surgical landmarks. Methods All human cadaveric heads were dissected at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. The dissection anatomic protocol was designed as follows: 1) virtual surgery simulation systems, 2) navigated cadaver dissection, and 3) postdissection analysis and quantification of data. Results The virtual dissection of the selected approach, the preliminary exploration of each specimen, the real dissection laboratory experience, and the analysis of data retrieved during the dissection step provide a complete method to improve general knowledge of the main endoscopic endonasal approaches to the skull base, at the same time allowing the development of new surgical techniques. Conclusions The methodology for surgical training in the anatomic laboratory described in this article has proven to be very effective, producing a depiction of anatomic landmarks as well as 3D visual feedback that improves the study, design, and execution in various neurosurgical approaches. The Dextroscope as a virtual surgery simulation system can be used as a preoperative planning tool that can allow the neurosurgeon to perceive, practice reasoning, and manipulate 3D representations using the transsphenoidal perspective acquiring specifically visual information for endoscopic endonasal approaches to the skull base. The Dextroscope also can be used as an advanced tool for analytic purposes to perform different types of measurements between surgical landmarks before, during, and after dissection. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
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